Pemetrexed and cisplatin chemotherapy
This information is about a chemotherapy treatment called
pemetrexed and cisplatin. It is used to treat mesothelioma and some types of non-small cell lung cancer.
The drugs that are used
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The treatment involves the two chemotherapy drugs: pemetrexed, which is also known as Alimta®, and cisplatin.
How treatment is given
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Pemetrexed and cisplatin can usually be given to you as a day patient. Before your treatment begins, you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. You'll also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near their collarbone (central line), or passed through a vein in the crook of their arm (PICC line). A central or PICC line will almost certainly be needed if you have your treatment as an outpatient. Your doctor or nurse will explain more about this to you.
Before the chemotherapy you'll be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula or central/PICC line, which will be connected to a drip (infusion). However, some anti-sickness medicines may be given as tablets.
The chemotherapy drugs are then given separately:
Pemetrexed (a clear fluid) is given as a drip (infusion) through your cannula or line. The infusion will take about 10–15 minutes. Before the treatment, you will be given steroid tablets to take as these help prevent a skin reaction (see page 3).
Cisplatin (a colourless fluid) is also given as an infusion that takes up to two hours. Before and after the cisplatin, you'll be given plenty of fluid through the drip to keep your kidneys working normally. This may mean that you have to stay in hospital overnight. This is sometimes called pre and post-hydration.
You'll be given folic acid and vitamin B12 to take before your treatment with pemetrexed begins, and throughout your chemotherapy. It's very important to take folic acid and B12, as they reduce the side effects of pemetrexed without reducing its effectiveness.
Vitamin B12 is injected into a muscle one week before the first treatment and again with every third treatment with pemetrexed (roughly every nine weeks).
Folic acid can be taken as a tablet. It's usually taken a few days before the first treatment and then every day until three weeks after treatment with pemetrexed is completed.
If you're having your treatment as a day patient, you can go home once it's finished. The cannula will be removed before you go. If you have a central or PICC line, it will usually stay in place ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll be given anti-sickness drugs to take home with you. It's important to take these as directed, even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the pemetrexed cisplatin regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of your chemotherapy treatment.
On the first day of your treatment, you'll be given both pemetrexed and cisplatin as infusions, as described. You'll then have a rest with no chemotherapy for 20 days. This completes what is called a cycle of treatment. Each cycle lasts 21 days (three weeks).
You'll start the next cycle of your treatment after the rest period, which will be three weeks after your first injection. Usually six cycles are given over a period of five months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has this treatment.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Feeling sick (nausea) and being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally, it may last longer. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs which may work better for you.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Risk of infection
Pemetrexed and cisplatin chemotherapy can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Pemetrexed and cisplatin chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Pemetrexed and cisplatin chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Pemetrexed and cisplatin chemotherapy can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Numbness or tingling in hands or feet
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Pemetrexed may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
Pemetrexed can cause a rash, which may be itchy. Your doctor can prescribe medicine to help. To help prevent or reduce skin reactions, the steroid dexamethasone should be given with each treatment. The steroid is usually taken for three days starting on the day before pemetrexed is given.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Your kidneys may be affected
This doesn't usually cause any symptoms, and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem – for example, if you're feeling sick.
Occasionally during treatment, you may get a strange, metallic or bitter taste in your mouth. Some people find sucking on a strongly flavoured sweet or mint helps to disguise this. You may also notice that food tastes different, but your normal taste will usually come back after treatment is over.
Less common side effects
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Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Signs of an allergic reaction can include hot flushes, backache, headaches and swelling of the face and a feeling of tightness in the chest. Let your nurse know straight away if you experience any of these.
The nurse will stop the drip and the symptoms will gradually go. The drip will then be restarted and there are usually no further allergic reactions. Your doctor may prescribe a drug that can reduce these side effects and it can be given before your next treatments.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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While you're having pemetrexed, it‘s best to not use any folic acid supplements other than those prescribed by your cancer specialist. Some multivitamins or food supplements contain folic acid, so you should consult your pharmacist before taking these.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
You should tell your doctor if you're taking any medicines for pain or inflammation called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. NSAIDs can sometimes increase the side effects of pemetrexed. Your doctor will tell you which medicines you can take and the best times to take them.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having pemetrexed and cisplatin chemotherapy, as it may harm the developing baby. It's important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our pemetrexed and cisplatin fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.